To report a multi-institution outbreak caused by a single strain of methicillin-resistant Staphylococcus aureus (MRSA).
Between September 19 and November 20, 1996 an index case and five secondary cases of nosocomial MRSA occurred on a 26 bed adult plastic surgery/burn unit (PSBU) at a tertiary care teaching hospital. Between November 11 and December 23, 1996, six additional cases were identified at a community hospital. One of the community hospital cases was transferred from the PSBU. All strains were identical by pulsed-field gel electrophoresis. MRSA may have contributed to skin graft breakdown in one case, and delayed wound healing in others. Patients required 2 to 226 isolation days.
A hand held shower and stretcher for showering in the hydrotherapy room of the PSBU were culture positive for the outbreak strain, and the presumed means of transmission. Replacement of stretcher showering with bedside sterile burn wound compresses terminated the outbreak. The PSBU was closed to new admissions and transfers out for 11 days during the investigation. Seven of 12 patients had effective decolonization therapy.
Environmental contamination is a potential source of nosocomial MRSA transmission on a burn unit. Notification among institutions and community care providers of shared patients infected or colonized with an antimicrobial resistant microorganism is necessary.
The United States Army Institute of Surgical Research was asked to provide burn care assistance in June 1989 following the explosion of leaking methane/propane gas in the Central Soviet Union, which destroyed two passenger trains and injured 800 passengers. A 17-member burn team flew from San Antonio, Texas, to Ufa, USSR and assisted in the management of 150 burn patients in a general medical-surgical hospital. Early problems included heavily colonized burn wounds, with a microbial flora that demonstrated broad antibiotic resistance. As wound complications were controlled, 28 operative procedures were performed to excise and graft the burn wounds. The recommendations for burn disaster management, based on our experience in Ufa, should be of assistance to other groups that may be asked to provide similar assistance in the future.
A group of US surgeons and nurses was invited by the Soviet surgeons and nurses of the Burn Unit of Childrens Hospital 9 to return to Moscow to participate in the evaluation and treatment of a group of 25 children burned in the Bashkir train-gas pipeline accident of 4 June 1989. The US group had participated in the acute care of the children 7 months before. Major sequelae observed were hepatitis, cardiomyopathy and severe emotional disorders. Reconstructive surgery for burn scars was jointly planned and carried out during a 2-week period of mutually instructive cooperation.
